Oral health-related quality of life changes in patients with severe Class III malocclusion treated with the 2-jaw surgery-first approach

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In this nonrandomized prospective study, we compared the effects of the surgery-first approach with conventional 2-jaw orthognathic surgery on skeletal Class III patients' oral health-related quality of life (OHRQoL), quality of the orthodontic outcome, and average treatment duration.


The sample consisted of 16 patients with severe skeletal Class III malocclusion, who needed 2-jaw orthognathic surgery: 8 were treated with the surgery-first approach, and 8 were treated with the traditional orthodontic-surgical approach. OHRQoL was assessed by using the Orthognathic Quality of Life Questionnaire (OQLQ) and the Oral Health Impact Profile-short version (OHIP-14). Malocclusion severity and esthetic self-perception were assessed with the Index of Orthodontic Treatment Need. Dental health status was determined using the Decayed, Missing and Filled Teeth Index. Tests were repeated at 7 times: baseline, 1 month after appliance placement, and 3 months, 6 months, 1 year, and 2 years after the beginning of the treatment; and for both groups, there was an also evaluation stage after the orthognathic surgery.


After 2 years, the surgery-first group showed a significant decrease in malocclusion severity (P <0.001) and had significant reductions in OQLQ (P <0.001) and OHIP-14 scores (P <0.001). These changes began after the orthognathic surgery and were progressive throughout the evaluation periods. In the traditional orthodontic-surgical approach group, after 2 years of monitoring, all patients were still in the preoperative orthodontic preparation phase, and their malocclusion severity increased significantly, thereby resulting in a not statistically significant worsening of their OHRQoL (OHIP-14, P = 0.89; OQLQ, P = 0.11).


OHRQoL improved significantly in a linear trend of progressive improvements in all severe Class III patients who had the surgery-first approach after the surgical procedure through 2 years of follow-up, as their malocclusion and esthetic self-perception also improved.

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